Submission Declaration and Author Warranties
- •It is original work, has been written by the stated authors, and has not been published elsewhere, including electronically, in the same form, in any language. Likewise, a similar manuscript has not been submitted to or published by any other journal, by any of the authors.
- •Any manuscript submitted to Arthroscopy is not currently being considered for publication by any other journal and will not be submitted for such review while under review by this Journal.
- •If the submission is accepted, it will not be published elsewhere, including electronically in the same form, in any language, without the written consent of the copyright holder.
Before You Begin
Disclosure of Potential Conflict of Interest
- 1.Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND
- 2.Drafting the work or revising it critically for important intellectual content; AND
- 3.Final approval of the version to be published; AND
- 4.Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Registration of Clinical Trials
Separate Title Page
- •Title. Concise and informative. Titles are often used in information-retrieval systems. Avoid abbreviations and formulae where possible.
- •All Authors’ full names, degrees, and affiliations. Where the family name may be ambiguous (e.g., a double name), please indicate this clearly. Present each author’s affiliation and address below the names.
- •Corresponding Author. Clearly indicate who will handle correspondence at all stages of reviewing and publication, and after publication. Ensure that telephone numbers (with country and area code) are provided in addition to the e-mail address and the complete postal address. Contact details must be kept up to date by the corresponding author.
- •In addition, include IRB and RCT information, as well as a short running title (maximum of 45 characters and spaces). Include any acknowledgment of persons who provided help during the research/writing (e.g., language help, writing assistance, or proof reading the manuscript, etc.).
Blinding the Manuscript
|Type of Article||Number of Words|
|Figures (Figure Parts)||Tables|
|Original Article||4,000||7 (15)||4|
|Level V Evidence|
|Systematic Review||4,500||7 (15)||4|
|Case Report (rarely accepted)||—||—||—|
|Letter to Editor & Reply||500||2 (2)||0|
8 Figure and Video Legends
Systematic Reviews (with and without meta-analysis)
- •Rationale for why a SR is needed should be clearly described. What is already known about the topic, current gaps in knowledge, and why a SR is likely to produce evidence that will serve to address these gaps should be clearly stated. If a similar or identical SR/MA has been published in last 5 to 10 years, then the submitted SR/MA must show that the evidence has changed.
- •Define the specific research question, preferably in PICO format (Participants, Interventions, Comparisons, and Outcomes).
- •Example: In collision athletes, does open Bankart repair, in comparison to arthroscopic Bankart repair, result in lower rates of recurrent instability?
- •Eligibility criteria should follow the PICO question defined in the Introduction.
- ○Example: Studies that included collision athletes with a Bankart lesion undergoing primary repair, compared open to arthroscopic treatment, and reported recurrent instability rates at two years or greater follow up were eligible for inclusion.
- •Other pertinent criteria for determining eligibility including type of studies (Level of Evidence, study design, etc.) that was reviewed.
- ○Example: Case series (Level IV evidence) or studies that did not specifically compare open to arthroscopic treatment were excluded.
- ○Consult CEBM (http://www.cebm.net/ocebm-levels-of-evidence/) for thorough descriptions of level of evidence in therapeutic, diagnostic, prognostic, and economic studies.
- •The search strategy (terms, string) should be described with enough detail that it could be reproduced.
- •Indicate which databases were searched. Two or more databases should be used (the combination of MEDLINE, EMBASE, and Cochrane will capture 97% of all relevant studies in Orthopedic Surgery SR/MA).
- •The search should be performed independently by two or more study authors to ensure no omission of potentially relevant subjects and resolution of disagreement in the setting of possible study inclusion.
- •The process for selecting studies, indicating who screened the studies and how were disagreements managed should be clearly described.
- •The specific data that were extracted from each study and information on who abstracted the data, what tools (data collections forms, etc.) were used to facilitate abstraction, and how were disagreements managed should be described.
- •The process used to appraise the methodological quality or risk of bias including the tools use for appraisal should be clearly described.
- •The tools used to evaluate the studies should be appropriate for the design of the included studies. Common tools include Cochrane’s Risk of Bias for randomized clinical trials, Coleman, Modified Coleman, CONSORT, Newcastle-Ottawa or MINORS for observational non-randomized studies.
- •Multiple, independent raters for the risk of bias assessment are recommended. Rater statistics (kappa, ICC) should be reported to quantify the degree agreement between the raters and a description of how disagreements were handled, i.e. how the final score was arrived at, should be included.
- •The primary outcome measure(s) should be clearly stated.
- ○Example: The primary outcome measure was the rate of recurrent instability. Risk ratios (rate in open group divided by the rate in arthroscopic) were calculated for each study.
- •If a meta-analysis is performed, the rationale or criteria used for determining that pooling data was appropriate should be provided.
- •In nearly all situations, meta-analysis should only be performed with level I or II evidence studies.
- •The methods used to analyze the data (fixed versus random effects) and measures of heterogeneity or consistency (I2) should be clearly described.
- •For a meta-analysis using a random effect model, prediction intervals are strongly recommended.
- •Plans for exploring heterogeneity or inconsistency between studies, including subgroup analyses and meta-regressions should be clearly described.
- •Any additional analyses (sensitivity, publication bias) should also be clearly described.
- •Presentation of the results should follow the Methods section.
- •The study selection process should be depicted in a PRISMA flow chart.
- •Risk of Bias scores should be presented for each item on the selected tools. Reporting aggregate scores is OK however scores for each item are needed to determine the specific areas where studies were at risk for bias.
- •For SR without a meta-analysis, forest plots with the summary estimate suppressed are recommend as they allow the effects of the individual studies and their relative size and weight to be displayed together in the same figure.
- •Including studies with duplicate patient populations. In some instances a SR turns up studies on the same patient group. Including these studies in any statistical analysis artificially inflates the number of patients and should be avoided.
- •Pooling diverse, heterogeneous studies with different designs. Combining non-randomized studies with randomized trials is typically not appropriate as these designs carry different risks of bias and are apt to distort the results. If a SR includes studies with different designs (randomize trials, cohort studies, etc.) these should be pooled separately. Typically, these are level III or IV evidence studies.
- •No rationale for provided for pooling non-randomized studies. If the available literature is limited to observational studies, a rationale for why a meta-analysis will produce valid results that contribute to the understanding of the problem under question is needed. If one can not be reached, a meta-analysis should be avoided.
- •Quantifying heterogeneity but not failing to explore or discuss it. Reporting of the I2 statistic has become more frequent however it’s important to discuss its impact on the results. If the results are heterogeneous efforts should be undertaken to explore this inconsistency. Techniques like subgroup analysis can be used to determine if I2 values change when grouped according to co-variants. For example, I2 values may change when the studies are analyzed according to a clinical characteristic (those that included patients with bone loss vs. those that did not) or a risk of bias item (those that adequately randomized patients versus those that did not). Lastly, I2 is a relative measure. As recommended above, providing a prediction interval will assist in interpreting the effect of heterogeneity. A prediction interval provides a range of probable effects that reflects the variation in the different studies and settings, including what would be expected in future patients.
- •E-mail address
- •Full postal address
- •Telephone numbers
- •All figure legends
- •All tables (including title, description, footnotes)
- •Separate files for figures
- •ICMJE forms for all authors, combined into a single PDF
|Study Type||Question||Level I||Level II||Level III||Level IV||Level V|
|Diagnostic –Investigating a diagnostic test||Is this (early detection) test worthwhile?|
Is this diagnostic or monitoring test accurate?
|Prognostic –Investigating the effect of a patient characteristic on the outcome of a disease||What is the natural history of the condition?|
|Therapeutic – Investigating the results of a treatment||Does this treatment help? What are the harms|
|Economic||Does the intervention offer good value for dollars spent?||Computer simulation model (Monte Carlo simulation, Markov model) with inputs derived from level I studies, lifetime time duration, outcomes expressed in dollars per quality-adjusted life year’s (QALYs) and uncertainty examined using probabilistic sensitivity analyses||Computer simulation model (Monte Carlo simulation, Markov model) with inputs derived from level II studies, lifetime time duration, outcomes expressed in QALYs and uncertainty examined using probabilistic sensitivity analysis||Computer simulation model (Monte Carlo simulation, Markov model) with inputs derived from level II studies, relevant time horizon, less than lifetime, outcomes expressed in QALYs and uncertainty examined using stochastic multilevel sensitivity analysis||Decision tree over the short time horizon with inputs data for original level-II and III studies and uncertainty as examined by univariate sensitivity analysis||Decision tree over the short time horizon with inputs data informed by prior economic evaluation and uncertainty as examined by univariate sensitivity analysis|
- •MPEG-1 or MPEG-2 (.mpg)
- •MP4 (.mp4)
- •QuickTime (.mov)
- •Each video must start with a slide listing the authors’ conflicts of interest.
- •Submit a single video per manuscript, not multi-part videos.
- •Maximum length of videos is 4.5 minutes.
- •Video file may not exceed 100 MB.
- •Please ZIP the file and upload the zipped file to hasten the upload time.
- •A complete legend for the video must be included in the manuscript.
- •Video must be cited in the text of your manuscript just like a figure.
- •A sound track is highly desirable and is requested.